SCOTLAND

Anthony Steen: I congratulate the Secretary of State on his elevation, or whatever it is. When he does visit the Parliament, could he find out—by means of a bit of detective work, perhaps—why all Scots get free eye tests, whereas in England that applies only to the elderly, the very young and those on benefits? Is it because the Scots have worse eyes?
	Could the Secretary of State also explain why Scots opticians receive 28.50 from the national health service for every test that they give, while opticians in England receive only 18.30? Where does the money come from?

David Cairns: The hon. Gentleman is aware that no decisions have been taken about the size and shape of the post office network, following either the 2006–08 period or the end of the Post Office card account in 2010. The track record of the Government, investing thousands of millions pounds in the Post Office, speaks to our genuine belief that the Post Office has a role to play, and we will continue to support it.
	I fail to see, once again, how the Liberal Democrat policy of privatising the Post Office and abolishing it—

CONSTITUTIONAL AFFAIRS

Mark Pritchard: What the level of unpaid fines was in 2004–05.

Harriet Harman: In 2004–05, the level of unpaid fines, costs and compensation was 19 per cent. To increase the payment rate we have introduced attachment of earnings for fines to be deducted out of the pay packet. We can now clamp cars for unpaid fines, and courts have appointed fines' officers who will agree the payment rate and make sure that it is kept to.

David Kidney: The high-profile initiative nationwide to collect outstanding fines has been noticed by my Stafford constituents. [Interruption.] Will that more intensive activity continue in future, or is it a temporary initiative?

LEADER OF THE HOUSE

HOUSE OF COMMONS COMMISSION

Gordon Prentice: What the cost was of storing statues owned by the House but not on display in 2005–06.

Nick Harvey: All the statues that the House of Commons owns were on display in 2005–06, so no charges for offsite storage were incurred.

LEADER OF THE HOUSE

Misuse of Drugs (Reclassification of Methylamphetamine)

Bob Spink: I beg to move,
	That leave be given to bring in a Bill to reclassify methylamphetamine as a category A drug.
	This is yet another sad tale of a failing Home Office. This time, it is failing to protect people from the misuse of crystal meth, which is seriously bad news for individuals who use it and for society at large.
	The widely respected New York police chief, Anthony Izzo, told the Select Committee on Science and Technology:
	"Crystal meth makes crack cocaine look like a Hershey Bar."
	He bases his view on hard evidence and experience. UK Sky TV news coverage showed the drug's impact on individuals and called for Government action before use of this nasty drug becomes endemic. But the Home Office says that it is not yet very prevalent in the UK and that, in effect, they will reclassify when a greater number of people have been damaged and communities are suffering more serious consequences. That is hardly the precautionary approach that the public deserve. It is hardly the action of a Government who care about their young people or want to minimise the impact of drug abuse on society.
	Methylamphetamine is one of a group of psychostimulant drugs called amphetamines that act on the brain and nervous system. It is produced in tablet, powder or crystalline form. It is taken orally, snorted or injected, but unlike amphetamine, it can be smoked.
	The term "crystal meth" is often used for the purer crystalline form. The drug's street names include "yaba" for tablet form, "ice", "glass", "Tina", "Christine" and "Nazi crank". It was first developed in 1919 and used by troops to keep awake. It was rumoured that Hitler injected it twice a day, hence the name "Nazi crank". The chances of getting hooked are incredible compared with other illicit drugs. Psychological and physical dependence happens quickly. It affects the brain reward pathways. Users must take more to achieve the same effects, as tolerance quickly builds up. Using the drug by intravenous injection or smoking is especially likely to cause addiction. Smoking the purer, crystalline form produces an intense rush, similar to that of crack cocaine, but much longer lasting—not only minutes but four to 12 hours. That is highly reinforcing and becomes highly addictive. The higher potency, especially when smoked, makes the drug a greater threat. It is, all too often, a one-drag-and-you're-hooked drug.
	The drug's effects are appalling. They include agitation, paranoia, confusion and violence, usually against innocent bystanders. It damages more than those who take it. It can bring on feelings of exhilaration and produces increased arousal and activity levels. It causes a rapid rise in heart rate and blood pressure, and the higher the dose, the greater the effects.
	The risks are enormous. Methylamphetamine-induced psychosis has been widely reported in countries where use has become endemic. High dosages lead to strokes and pulmonary, renal and gastrointestinal disorders. Coma and death can and do follow. It is a much more serious drug than the class A ecstasy that killed Leah Betts in Essex a decade ago. Yet the Government appear to have learned nothing from that tragic wake-up call.
	Methylamphetamine is often injected, with sharing of paraphernalia and all the consequences of infection. The drug also increases libido and risky sexual behaviour, thereby increasing blood-borne virus transmission. Home Office research shows that the drug is especially used by the homosexual community. It is disastrous for that group to reduce sexual inhibitions or undertake ever more risky behaviour.
	Methylamphetamine is currently a class B drug under the Misuse of Drugs Act 1971. That historical classification results from the drug's chemical association with amphetamines, which were all classified B. The Advisory Council on the Misuse of Drugs, which reports to and advises the Government on the classification of drugs, is as dysfunctional as the Home Office. It meets just twice a year with a quorum of only seven, but comprises 38 people, some of whom are caring, knowledgeable, professional and sensible. However, too many represent a neo-liberal, politically correct rag-bag, who appear to make decisions without excessive reference to the evidence and the consequences.
	James Randerson, science correspondent for The Guardian, reported on 24 April that Professor Rawlins, chairman of ACMD
	"blew the gaff on government claims that its drug policy is 'evidence based'."
	The classification for illegal drugs is riddled with anomalies and simply does not work. That is echoed by the Science and Technology Committee's research, which found:
	"Drugs are not classified on the basis of . . . the harm they cause."
	Indeed, they are not classified according to any consistent set of criteria. On 1 March, The Times home correspondent, Richard Ford, ran the headline:
	"Lax laws 'could turn Nazi crank into global epidemic'".
	The article stated:
	"A new highly addictive drug used in Britain by clubbers and gay men is becoming a global problem, according to a United Nations report.
	The huge increase in crystal meth is helped by lax restrictions on the chemicals used to manufacture it. People who take it can experience a ten-hour high and increased sexual arousal.
	Professor Hamid Ghodse, president of the United Nations' drug control agency, said:
	'If I want to pick on one major drug problem pandemic today, it is methamphetamine'."
	Yet, last year, the ACMD recommended that it remained a class B drug.
	Professor Nutt, a distinguished psychopharmacologist and chairman of the ACMD's technical committee, told the Science and Technology Committee that upping the classification could have the perverse effect of making the drug more desirable and thus stimulate demand. He argued that downgrading mushrooms might stimulate demand and that upgrading crystal meth would have the same effect. That is perverse and muddled thinking. I sometime wonder whether the ACMD is personally testing the products when making decisions.
	A shift up the scale could well give a drug more kudos, as Professor Nutt suggests. However, that undermines one of the key tenets of the United Kingdom's drug laws, which is that the more dangerous drugs should be placed in higher, not lower, categories because of the greater risks attached to them. The ACMD seems totally unimpressed by the principles of UK law, by international experience, or by the evidence base.
	Methylamphetamine can be produced in small domestic laboratories from non-controlled precursors. I will not go into details about those precursors today, as it would not be helpful. I have asked the Home Secretary to control those precursors, but he has not done so. The ACMD recommended close monitoring of the drug's use, but this is difficult because the extent of the drug's use in Britain is, in the words of the president of the UN narcotics control board,
	"hidden because seizures were included in figures for amphetamines".
	The Home Office confirmed that, stating:
	"The British Crime Survey does not differentiate between methylamphetamine use and amphetamines".
	I respectfully maintain that the Government are failing to control the drug's precursors and not effectively monitoring its usage. That is unsustainable. The Home Secretary said that he would publish a consultation paper on a review of the drug classification system. He has not yet done so, although he promised this on, I think, 19 January this year. So I call on the new Home Secretary to bring forward that review urgently, and to change the drug classification system to a more consistent and rational one. The Government should take a precautionary approach and immediately reclassify methylamphetamine as a class A drug, so that we can save individuals and society from its terrible consequences.

Misuse of Drugs (Reclassification of Methylamphetamine)

Opposition Day
	 — 
	[15th Allotted Day]
	 — 
	Management of the National Health Service

Andrew Lansley: I will give way in a moment, but first I want to make some progress.
	In July the Secretary of State said that the 2003–04 NHS deficit would be £140 million. Weeks later, the then NHS chief executive said that it was in fact £250 million. In August the Secretary of State had to reveal that the key health inequalities of life expectancy and infant mortality—both targeted by the Government—had widened. In September thousands of doctors were found by the BMA to be unable to find training posts. Junior doctors see training budgets being cut and a future severe shortage in the training posts available to them to fulfil their vocation.
	In October the Secretary of State said that primary care trusts should not refuse to provide Herceptin for early-stage breast cancer. By February her Department was telling the High Court that Swindon primary care trust's refusal to do so was not incompatible with Government policy. Also in October, the Secretary of State told the House that there was enough flu vaccine, but by November it emerged that she had confused UK-wide supplies with the at-risk groups in England only. On avian flu, she promised the House that she would have contracts with suppliers for items such as face masks and gloves. Those contracts have not yet been tendered for.
	In November, when we had a debate on the subject of NHS deficits, the Secretary of State told the House that the Government would reduce the NHS deficit this year compared with last year. We told the House that despite unprecedented resources, the trusts were in deficit to the tune of £600 million last year—2004–05—and predicted deficits approaching £1 billion for 2005–06.

Tom Levitt: It is worth bearing in mind the fact that the hon. Gentleman and his party have voted against extra money for the NHS on every occasion. Is it a fact that the general deficit for the NHS for the year just gone was around 1 per cent., and in 1996–97 it was 1.5 per cent.? Deficits under this Government have been lower than under the Tories.

Andrew Lansley: It is a fact that in the year of the 1997 general election NHS bodies started spending money virtually without constraint, in the expectation that a Labour Government would bail them out. My right hon. Friend the Member for Charnwood (Mr. Dorrell) might recall that. The hon. Gentleman is also right to say that the deficit for the year just gone probably will be about 1 per cent. of NHS resources. However, the NHS is a body that is voted a certain sum of money by Parliament, and for it to spend more than that is serious. In my book, several hundred million pounds is very serious.
	It is also true that between 1997 and 2002 there were no system-wide deficits in the NHS, but hospital trusts in England finished the year before last with an accumulated deficit of some £300 million. They finished 2004–05 with a deficit of some £600 million, and they will have finished the last financial year with a deficit of some £1.1 billion. The hon. Gentleman and many other Labour Members will be wondering why strategic health authorities are cutting a third of their additional allocation to primary care trusts this year to hold the sum as a reserve. It is because they need some £1.5 billion this financial year to bail out the accumulated deficits and the underlying deficits that hospitals are experiencing.

Ann Coffey: I want to return to what the hon. Gentleman said about payment by results—[Interruption.] I have been trying to intervene for some time on that point. I heard his criticism of the Government's scheme, but does his party support the introduction of a national tariff? If not, what changes would it make?

Andrew Lansley: Yes. If hospitals were genuinely free and given the opportunity to behave in a businesslike way they would be able to make different arrangements for their financing needs. Indeed, some PCTs are doing just that; things are getting so desperate in the NHS that a PCT in my constituency has borrowed £2.5 million from the local authority. However, I must make progress because we have only reached the new year.
	In January, the Secretary of State's operating framework for 2006–07 said that new guidance on PFI would be published, with the effect of cutting the PFI programme by a third. The guidance never appeared and it is reported that it has gone into limbo, and nobody with a PFI project in prospect knows what will happen. The same document stated that in this financial year
	"for the system as a whole we expect to recover any overspend from 2005/6 and we are planning for a surplus."
	It said that individual NHS bodies should plan both to achieve in-year balance and recover 2005–06 deficits.
	On 12 April, the Secretary of State for Health sent me a letter in response to my inquiries. She said that the objective has changed:
	"All organisations are overspending to show improvement during 2006–7, and by the end of the year everyone should have monthly income covering monthly expenditure."
	What kind of financial balance is that? It happens to coincide with the 12th month of the financial year. The Government's policy has completely changed. They did not tell the House about it; it emerged from a letter written to me. The policy is no longer to achieve financial balance in 2006–07—it may not even be to do so in 2007–08. We simply do not know what is the Government's policy to restore NHS finances.

Andrew Lansley: She did. [Interruption.]
	On 22 February, the Department withdrew the NHS tariff on the basis that it had underlying errors. Hon. Members might wonder what sort of underlying technical errors they might be. They were really complicated things: the Department was supposed to take £140 million from patient transport, but it only took £140. Things like that happened. So the NHS did not get its tariff until 10 working days before the start of the new financial year.
	It became clear in February and March, too, that the Government's legislative programme had collapsed. The new Leader of the House is here, and I welcome him to his post. I am sure that he will be interested to know that the Department of Health was given the benefit of three measures in this legislative programme, but the policy on the Health Bill collapsed and the Government had to do a U-turn, the NHS Redress Bill has been radically changed in the Lords from the Government's original proposals and the draft Mental Health Bill has been abandoned. We simply do not know when the Government's new and, I hope, better proposals will arrive.
	In March, the trauma got worse. Deficits turned to disasters. On 7 March, Sir Nigel Crisp resigned. The chief executive took responsibility for the problems of the previous months—what a pity Ministers did not.

Hon. Members: Get on with it!

Steve Webb: It is interesting that the Conservatives want immediately to get the focus off where they stand on these issues. I have here a copy of the letter sent by the leader of the Conservative party to his colleagues. In summary, it says, "They don't trust us on the NHS; we'd better do something about it. Let's join leagues of friends. Let's have some Opposition day debates. Let's do some visits. Let's try to deal with the terrible reputation we have on the NHS." Well, that will not wash—[Interruption.] I am asked whether the Conservatives are just faking it. Why did the shadow Secretary of State for Health vote against an £8 billion rise in national insurance for the national health service—[Interruption.] I am told that that would have been the wrong way to raise the money, but I was not aware of an alternative £8 billion tax increase being proposed. Perhaps the Conservatives had secret stealth tax plans. Who knows?

Steve Webb: My hon. Friend, who is relatively local to Alder Hey, has raised an important point. What we need are long-term efficiency strategies, long-term reform and structured change. What we are getting are emergency cuts packages, and that is not a rational way in which to run the health service.
	The Secretary of State talked about job cuts, implying that they involved just a few agency staff; and who would not want to cut agency staff? I recently received a letter from a young woman in Stoke-on-Trent; well, a relatively young woman. She writes
	"I work at the University Hospital of North Staffs . . . After nearly eighteen years of loyal service . . . it seems according to the Government's 'turn around' team that my services are no longer needed . . . we as a Trust have worked really hard to meet all the Government's targets . . . we are being rewarded with job losses and cuts to patient care".
	That is just one example, but it is disingenuous to say that this is all about agency staff. It is not solely about them. Clearly things can change, but we are talking about permanent and front-line staff. We are talking about doctors and nurses. This is having an impact not just on services but on morale. As the Secretary of State herself knows from experience, we need good will and good morale above all in the NHS. So much runs on that basis, and the Government are systematically undermining it.

Steve Webb: I am aware of the centre to which the hon. Gentleman has referred. An early-day motion has been tabled in its support, to which I added my name recently because I share the hon. Gentleman's concern.
	Is it just a bit of waste and inefficiency that is being eliminated, or is it front-line services? I received a letter from a psychoanalytical psychotherapist—also from Stoke-on-Trent—who says that the local PCT is saying this:
	"less vital work . . . elective operations, help with hearing and eyesight . . . orthopaedic care, health promotion and some mental health care will be given a lower priority because of the need to protect life or death care".
	Of course we want to protect "life or death care", but this does not mean just stripping out a few agency nurses; it means cutting a raft of services that constitute the bread and butter of the NHS.

Steve Webb: The hon. Gentleman cannot have it both ways. I do welcome the extra investment in digital hearing aids, but if people have to wait longer because of induced demand, the Secretary of State cannot claim that the Government are abolishing waiting in the NHS.
	A case of what waiting is doing to people was drawn to my attention only this week. A consultant at Guy's and St Thomas' hospital wrote to a lady—who sent a copy of the letter to me—about a genetic blood test for breast cancer. The consultant wrote:
	"You remember that testing your blood within the NHS will take somewhere between 6–9 months".
	The Government's motion states that they welcome
	"the fact that all patients can now expect to wait no longer than six months for their operation".
	However, they will not get that far if they have to wait six to nine months for the blood test. The consultant concludes, ominously, that that
	"will be too late to help you make a treatment decision for your suspected breast cancer. Another possibility is that you pay £1,800.00 to send your blood sample to the US to a private company . . . which will deliver a result within 4–6 weeks."
	That is the NHS in which the Government have nearly abolished waiting.

Steve Webb: The hon. Lady raises the important issue of what the NHS does and does not do, which is separate from the issue of waiting. If some people cannot get treatment at all, it is another facet of that problem.
	We should also talk about what needs to be done. I listened in vain for nearly 45 minutes to the hon. Member for South Cambridgeshire for any suggestions, and there is nothing in his motion about what needs to be done. A constructive and effective Opposition says what needs to be done, so I shall point out several measures that need to be taken.
	The first is that if one accepts the Government's logic, the NHS should be given greater time to adjust. If one believes in a market directed by incentives—including incentives to be more efficient—it needs time to adjust. Incentives do not work over night. If the NHS is to be restructured, new units built and old ones closed, the effect will take time to be felt. The logic of the Government's position is that we should not have wholesale reform all at once to be implemented quickly. Instead, change should be phased, staged and managed, but that is not what is happening. One cannot sort out the problems of decades in weeks.
	The second key aspect is the need, at the very least, for the infamous level playing field between the NHS and the private sector. All too often, the independent treatment centres, which are supposed to be the dynamic, free-market, capitalist competition that will ensure efficiency, are being subsidised and given guaranteed business. That is the exact opposite of what should happen. For example, a doctor wrote to me recently saying:
	"One contributing factor"—
	to the problems of the NHS—
	"is the . . . Treatment Centre . . . in Shepton, which is treating straightforward patients for routine ops at an inflated tariff and leaving the more complex cases, as well as sorting out their errors, to the local NHS."
	He makes an interesting point when he states that the number of staff working there is very similar to the number of redundancies at the Royal United hospital, Bath. He says that that is no surprise, as those staff members are doing the work that the RUH has lost, although at a higher price. That cannot be a rational way to manage efficiency in the health service.
	The shadow Secretary of State, the hon. Member for South Cambridgeshire, asked about what should happen when a district general hospital "loses business", as the jargon has it. He did not answer his own question, but the logic of the Government's policy is clear, and it is that district general hospitals may close when their work can be taken up by regional specialisms, treatment centres and GP surgeries. However, have the Government talked to the British public about that? Has there been a debate about whether we think that district general hospitals have a future?
	The answer to both questions is no. We have had no such debate. What is missing most of all from the NHS is real local democratic accountability. The NHS employs 1.3 million people, or one voter in 35. The only person democratically accountable to all those people is the Secretary of State, who has just left the Chamber.
	I shall give the House an example from my own part of the world. In the former area of Avon, none of the local MPs and councillors, regardless of party, wanted the PCT configuration, but the health authority just said, "Tough." Where is the democracy and accountability in that?
	That is not merely a constitutional point. We want the NHS to be genuinely accountable and answerable to us not just because we pay for it, but because that would be more efficient. Local people and those whom they elect would be able to scrutinise what went on and ask pertinent questions. At present, they are completely shut out; only one person is accountable for the NHS, and she takes no responsibility for it.
	Over the past nine years, the amount of money going into the NHS has risen from historically low levels to something more credible, but the problem has been the endless interference and issuing of diktats from the centre. Local discretion has been limited, but the blame when things go wrong is always shifted to local NHS management.
	That has to stop. We want real local democratic accountability, and that will mean that the NHS is different in different parts of the country. That is what local people want; they should be allowed to have it, and not be told from the centre how things are going to be.
	We should not go back to the pre-1997 regime that failed the NHS. There have been real improvements since then, but we need a measured pace of reform, serious accountability and decentralisation. Running an organisation of 1.3 million from one office in Whitehall is not the way to proceed.

Kevin Barron: I begin by saying how intrigued I am by the Opposition's motion today, which seeks a turnaround in the Department of Health. When I was in opposition, I sat on those Benches and demanded that the Conservative Government of the day save jobs in the NHS. Now, some Conservative Members are doing the same thing. That is the biggest turnaround in my experience of this House, although the difference is that there are now 300,000 more jobs in the health service than when they left office. [Interruption.] The hon. Member for Beverley and Holderness (Mr. Stuart) asks a question from a sedentary position, but I invite him to intervene. I am quite happy to take him on, but I see that he does not want to get up. That is okay, and I shall move on.
	The Opposition motion mentions the word "turnaround", but the greatest turnaround in our NHS began in May 1997. It may have taken a couple of years to take effect, but that was when the NHS started to get the expenditure that it had needed for a long time. I have to disagree with my right hon. Friend the Secretary of State when she says that 18 years of Conservative Government took money away from the NHS; the process began in 1976 under Denis Healey when he started to attack the NHS capital expenditure programme—an easy public sector target whenever a Government come under pressure. The cuts have decades of history and the process did not end for a long time, but it has ended over recent years.
	The Conservative motion suggests that the Secretary of State does not understand the realities of the NHS. I fundamentally disagree. My right hon. Friend knows fine well what the realities are. The hon. Member for Northavon (Steve Webb) referred to some of them when he talked of the need for staged change in the NHS. He said that the changes needed to be better timed, because things had been done in a bit of a rush. I have been hearing that in this place for 23 years. Before that I was active in local politics and I heard it there, too. Every time we ask for change in the NHS, we are told, "Yes, but don't do it now." I do not say that things could not be done better, but I suspect that the hon. Gentleman is listening to the voices of vested interests—people who work in the NHS and do not want to change. In certain circumstances, it is a great pity that they do not want to. We have all heard those vested interests in media reports over the past few weeks, and I have heavily criticised some of them.
	I want to set out what has been happening in the NHS since the Government took office in 1997. We have dealt with waiting times of more than six months, although earlier we heard an example that showed they were increasing again. In March 2000, three years after we took office, more than a quarter of a million people had to wait more than six months for an operation; by December 2005 the number was almost nil. The bar on the Department of Health graph is so small that I cannot see what the number is.
	In 1998–99 the mean waiting time for a cataract operation was 225 days; in 2004–05 it was 91 days—a reduction of 60 per cent. The mean waiting time for a heart operation in 1998–99 was 136 days; it is now 91 days—a reduction of 33 per cent. There has been a reduction of 19 per cent. in the waiting time for hip replacements and of 25 per cent. for the diagnosis of heart conditions. When I look at all those changes, I cannot recognise the NHS that was described earlier.

Kevin Barron: National health service funding has doubled since Labour came into office in 1997, and in two years' time it will have trebled; that relates to deficits. I do not want to talk about deficits in this debate, because the Health Committee, which I chair, will be looking into how trusts can run up massive overspends after the Government have given them increased budgets year on year for at least the last six years.
	In 1998–99 there were 201,000 cataract operations; in 2004 there were 306,000—a 52 per cent. increase. There was a 78 per cent. increase in heart operations over the same period, and an increase of 22 per cent. in the number of hip operations and 11 per cent. in the number of kidney transplants. The list goes on—[Interruption.] The hon. Member for Beverley and Holderness can sit there interrupting all day, but I am setting out facts that show what has been happening in our national health service over the past few years.
	Let us look at heart disease. Waits for heart surgery are down to less than three months. In March 2000, 2,800 people had been waiting more than six months, and it was not uncommon for patients to wait up to two years. The average waiting time for heart procedures is down by a third since 1998–99.

Kevin Barron: I will refer to the hon. Lady as my hon. Friend because she serves on the Health Committee, but I fundamentally disagree with her. She was out with the Committee going round the health service, both the independent sector and the NHS, just a few weeks ago, and I did not hear anger when I sat in rooms with nurses, some of them from the private sector—the independent sector, as it is called—and some of them from the NHS. I did not hear anger when we sat together, taking evidence for an inquiry that we are undertaking at the moment. I do not see that anger, but we get it from the top sometimes. We got it from the Royal College of Nursing, which, as I said in the media, was involved in a disgraceful attack—an attack on freedom of speech more than anything else. I remember standing on picket lines with health service workers, when there were 85,000 fewer nurses in our health service, because they were getting hammered at that time. [Interruption.] The hon. Member for Eddisbury (Mr. O'Brien) is at it again—if he wants to intervene, I am quite happy for him to do so. [Interruption.] No, he will have his say later.

Kevin Barron: That is absolutely right. I look forward to the RCN lobby on Thursday, when I will meet at least one of my constituents.
	I shall move on quickly. I was looking at heart disease. About 70,000 cardiac procedures were performed in 2004–05, which is a 59 per cent. increase in activity since 1998–99. In 2004 there were 15,300 fewer deaths from coronary heart disease than in 1997—a reduction of 35,000 since the baseline assessment of 1995–97. Cancer deaths are down by nearly 14 per cent. in the past seven years, saving about 43,000 lives. Some 600,000 additional women are being screened for breast cancer. Cancer consultants have increased by 43.7 per cent. since 1997. There are more than 1,300 more cancer consultants in this country. No one can say that cancer services have not improved massively in this country; they certainly have done.
	There are over 17 per cent. more diagnostic radiographers and over 24 per cent. more therapy radiographers than there were in 1997. Since April 2000, we have had 146 new MRI scanners, 135 linear accelerators, 224 CT scanners and more than 730 items of breast-scanning equipment. I only wish that all of them were being used as much as they could be in our NHS, so that we could get waiting lists down a lot more. That is the truth of what has happened in our NHS under this Government.

Stephen Dorrell: If the Secretary of State said that on 25 October, presumably, since the rest of the world knew that the matter was an issue of the moment, her ministerial colleague was aware of her answer when he gave evidence to the Health Committee on 1 November. Presumably the then Health Minister was expecting to be asked about the matter, yet he said:
	"I think we have set ourselves a long-term objective, yes, but I think what was clarified was the removal of the . . . timetable".
	What is the Government's policy on the subject?

Tom Levitt: The shadow Chief Whip is not in his place. The hon. Gentleman has criticised the words of some Conservative Members, and I am sure that the shadow Chief Whip will notice.
	Although there are no acute hospitals in the High Peak constituency, we have got a foundation three star hospital at Stockport Stepping hill, which is on the outskirts of my constituency, and a brand new hospital, which is awaiting the outcome of its foundation application, is about to be built to replace the present Tameside hospital. No one waits for four hours in A and E in either of those hospitals, and in-patients, who typically faced a 12-month wait in 2002, now wait for less than six months. Out-patient waits in the area were typically 21 weeks in 2002, but they are now less than 12 weeks.
	There are two PCTs in my constituency—Tameside and Glossop and High Peak and Dales—and they are both hitting all of their key targets, which benefits their patients, providing more and more services within communities and working closely with an excellent team of GPs. Furthermore, an increasing number of non-GP health staff are working inside GP surgeries delivering basic community health services. As far as Tameside and Glossop PCT is concerned, Shire Hill hospital in Glossop has now achieved step-up, step-down status, which means that people who do not need to take an acute bed can use a GP bed in that hospital. Similarly, people who have been in an acute hospital can use that hospital as a staging post on the way home. A walk-in centre will be built in Glossop through the local improvement finance trust programme, and I am delighted to say that the town has a high level of registration by dentists. Tameside and Glossop is an historically low-funded area, so I am pleased to say that it is getting a 9.4 per cent. increase this year and a 9.3 per cent. increase next year.
	High Peak and Dales PCT also has a record of excellence, although the locality is different. The Corbar maternity centre is a centre of excellence, and it was recently reopened and reinvigorated in Buxton. The Stonebench ward is one of the most deprived wards in my area, and for the first time it has both GP and dental services provided through PCT investment in the Sure Start programme. It also has the first four dentists employed by the NHS who do not have the option of going private. That historically high-funded area will still get an 8.1 per cent. increase this year and an 8.2 per cent. increase next year.
	There is an issue about the High Peak and Dales PCT budget, because—sin of sins—the PCT has overspent by 1 per cent. on its 2005–06 budget, which has resulted in the closure of the minor injuries unit in Buxton for eight hours a day between midnight and 8 am and the failure to bring an elderly person's ward at the Cavendish hospital back into use after refurbishment. I agree with the protestors who say that the minor injuries unit should be available 24 hours a day, and I hope that the PCT will make sure that it comes back into service in one form or another. Between midnight and 8 am, the unit used to serve an average of two people a night—on average, one of them would go to A and E, while NHS Direct would probably be able to deal with the other. Nevertheless, public pressure is such that the situation requires a response. Equally, I agree with the PCT that the elderly ward should be brought back into use first when the money becomes available. In dealing with that minor overspend, no redundancies have been necessary, and I hope that the situation will be corrected before too long.
	Like PCTs in other areas, PCTs in my area face reorganisation. Tameside and Glossop PCT is perhaps the only PCT which straddles a regional border—Tameside is the north-west region and Glossop is in the Trent region. Greater Manchester SHA has proposed that Tameside and Glossop should stay together, which recognises the local affinities, the local needs of Glossop, transport connections and travel-to-work areas. Indeed, 1,601 people replied to the public consultation in Glossop, of whom 1,597 supported maintaining the current link. Greater Manchester SHA only consulted on that option, while Trent consulted on four options, two of which would take Glossop back into Derbyshire in order to make a Derbyshire-wide PCT, which would be coterminous with social services. I understand that argument and see why social services and health services should be run according to the same boundaries, where no overriding feature exists. However, because of the geography of Derbyshire, and, in particular, the geography of Glossop, it is essential to maintain the link between Tameside and Glossop, and I hope that the Minister will announce the adoption of the status quo when he makes the announcement in a couple of weeks' time.
	I have already mentioned Corbar maternity unit. For some reason, the whole of High Peak is included in the north-west region, where a number of options are currently being considered for maternity and children's services. The consultation is open until the end of this week, and the large number of such units will be reduced to eight or nine in the Greater Manchester and north-west area, with the aim of improving staffing, quality, investment and opportunities for excellence. That idea has come from within the NHS itself—it is not being imposed from elsewhere. I am happy to tell the Minister that I have supported option A, which is already the preferred option, because it not only retains Corbar maternity unit in Buxton—in fact, all the options do that—but is the only one that maintains the maternity services at Tameside.
	Having said that, if Ministers find that there is an opportunity to show some flexibility, they might acknowledge that the reduction in choice from 13 or 14 units to around eight is a bit drastic. Perhaps they could consider the possibility of including Macclesfield in option A, because choice is an issue here. As someone who is used to representing a constituency on the fringe of a region, I am aware that one usually does not have as much choice as one does elsewhere.
	The NHS has been a huge success under Labour. More staff are employed and they are better paid than ever. There are more community services and more flexible services. There is an imaginative use of private capital to support and expand, not replace, public services, and there will be more to come. In the NHS, change is always difficult and challenge is always complex. Champions of health care, especially in our most deprived communities, are worth their weight in gold. The principles on which the NHS was founded, which, we are told this afternoon, are espoused across the Chamber, are safe with this Government. Equally, the funding that has been championed only on this side of the House is safe with this Government. We have a job to do with the NHS—let us get on and do it so that we have a better NHS for all.

Desmond Swayne: I remain absolutely convinced that my constituents are fortunate indeed to live where they do and to be served by the national health service, and I make no apology for that. Labour Members who have implied that there is no common ground between us and that some of us are not committed to the NHS do themselves, and us, no justice whatsoever.
	I caution Labour Members who have quoted reams of statistics at us with the intention of giving the impression that things are much better than they appear. I recall listening to "Yesterday in Parliament" during the late 1970s and mid-1980s, when Mrs. Thatcher was challenged week after week on the state of the NHS. She always answered robustly from the Dispatch Box with reams of statistics saying how many more operations had been carried out and so on. Even in those years, despite the myths that may be spun, the NHS was improving. Nevertheless, it did not work, because it did not match up to the ordinary people's perceptions based on their experiences. That is the problem that my constituents are having at the moment. Their perceptions of what is happening in the NHS are informed by the difficulty, or otherwise, that they face in seeing their doctor or dentist.
	I should like to give hon. Members an impression of what it is like in my part of the world. We have a vastly expanding population. As the Deputy Prime Minister's rules, particularly on density, begin to bite in urban centres such as New Milton, and townscapes are changed for ever as family houses are pulled down and replaced with blocks of flats, the population is expanding fast. Yet only one GP practice south of the A337 is still taking on new patients. That outgrew its existing premises some time ago and is short of space, whatever measure one chooses to use, and sometimes the cramped conditions in the waiting room are unacceptable. A few years ago the practice secured the primary care trust's permission in principle to expand its premises, but before it could do so, a directive from the Department of Health instructed that that was not to happen because the funds were to be allocated not to the primary care trust but to Hampshire as a whole. Hampshire's priorities are different; they apparently lie in Portsmouth. There is now not the remotest chance of that practice, or any practice in my constituency, being able to expand its premises.
	My constituents write to me in droves complaining that they can make an appointment with their GP only on the same day. It does not suit most people to have to spend hours ringing the surgery in the morning, only to find it engaged, when they would like to organise their lives so as to see the doctor at a time convenient to them, as they used to in the past. They feel that the situation is not as good as it was before. That is entirely a consequence of the targets to which general practitioners have been subjected.
	During the election campaign, on the "Question Time" interview, the Prime Minister was confronted with that problem, appeared greatly surprised, and said that he was going to do something about it. I have not noticed any result. I have written to the Secretary of State saying, "Please find enclosed a copy of a letter from my constituent complaining about X, Y or Z. I remember the Prime Minister saying he was going to do something about it—what has happened?" The answer is, "You can rest assured that patient satisfaction will be one of the measures on which general practitioners will be remunerated in future." That does not deal with the perceived deterioration that my constituents experience in booking an appointment.
	Let us examine the possibility of booking an appointment with one's dentist. A couple of years ago the situation deteriorated. It got so bad that constituents of mine who were lucky enough to have an NHS dentist were receiving letters telling them that there were not going to be any more NHS dentists, but they were welcome to stay on as private patients if they wished. When I raised that at Prime Minister's Question Time, the Deputy Prime Minister, who was answering on that occasion, said:
	"I am well aware of the problem that the hon. Gentleman mentions because I have experienced it. My dentist declared that he was going private and I declared that I could not stay with him. Many of our constituents have faced this problem. As the hon. Gentleman said, each one of us has been confronted with it."—[Official Report, 9 June 2004; Vol. 422, c. 270.]
	That does not actually address the problem. He went on to tell me that it was all the Tories' fault for having closed down the dental schools. A decision by the university grants funding body more than 10 years ago is not germane to our problem now. The problem is that NHS dentists are leaving the NHS. It is not a question of a shortage of dentists but of how they are employed.
	The problem got worse. Several constituents wrote to me complaining that they had received a letter from their dentist saying that he was no longer going to be an NHS dentist but would nevertheless continue to treat their children under the NHS as long as they, the parents, remained as private patients with the practice. They did not like being held hostage in that way, but felt fortunate at least to have their children still being treated as NHS patients. The Secretary of State acted to right that perceived wrong. Instructions were issued to primary care trusts whereby they were empowered to prevent dentists from maintaining children-only NHS lists. So in the past few months, parents in my constituency, particularly vulnerable families, have been receiving letters from those self-same dentists saying, in effect, "You will recall my letter of such and such when I undertook to keep your children on as long as you remained as a registered private patient at the practice—well, sorry, that deal is off and your children will either have to find another dentist or stay with me and pay." That is a very worrying letter for the many families with children who have orthodontic requirements and all sorts of work to be done.
	As a consequence of the Government's policy, it is much more difficult to secure NHS dental treatment. However, my constituents have been told that the seventh cavalry is on the way, and that some 12,500 new dental registrations will be available to the good people of New Milton. To take advantage of those as yet virtual dental registrations, a new model is to be used to avoid the inconvenience—and, of course, the attendant unpleasant publicity—of long queues forming and being photographed.
	The people of New Milton have been invited to telephone a number to secure their dental registration. I have a letter from a constituent who tried that. The announcement was made in February and he began to make telephone calls. The letter states:
	"Since then I and friends have telephoned this number many times only to hear an automated voice saying 'The number you called is busy. To ring back please press five'. Furthermore, if you press five a similar voice tells you 'Sorry, there is a fault please try again'."
	He writes that he tried the number on 3 April from 1.55 pm to 2.25 pm, from 3.30 pm to 3.50 pm and from 4.43 pm to 4.52 pm. He tried again on 4 April between 1.45 pm and 2.10 pm, and 4.10 pm and 4.35 pm. Each occasion met with the same result. Let that be a measure of the frustration of ordinary constituents in trying to secure the NHS treatment to which they rightly believe that they are entitled. Those perceptions mean that there is an understandable belief that things have got worse.
	We have been told that the position on waiting times has changed; the claim was repeated today. We are told that a magnificent improvement has occurred, but that is not the experience of many of my constituents. At previous Health questions, I asked about audiological waits in my constituency. It has a disproportionate number of elderly people, and thus a disproportionate number suffering from poor hearing, which is one of the most socially isolating experiences. As I said in Health questions, there is a significant danger that many patients will die before they secure the hearing aids that they require.
	Strangely, I received a letter about the problem today—although it is not an amazing coincidence, because I am afraid that I receive such letters almost every day. My constituent's 17-month wait for a hearing test was over in February. His appointment was on 6 February and the consultant told him that it would take three months for the hearing aids to be made up. My constituent wrote:
	"A reliable person tells me it ought to take . . . say, a fortnight."
	He waited and waited. After a further three months, he rang the hospital to find out what had happened to his hearing aids, only to be told that it would take another six months before they were delivered. That is a measure of ordinary people's experience of the health service. Can we blame them if they believe that it is getting worse?
	We have five community hospitals in New Forest. We launched a massive campaign in the past year to save them because the primary care trust intended to close them. It backed off and said that it no longer planned to close them, but that it would have to work with the community to find a role for them—exactly the model that the White Paper, which the Secretary of State launched, set out. There was, therefore, progress.
	However, community hospital supporters now experience huge frustration and staff morale is low because nothing has emerged from the process. Whatever is suggested about the role of a specific hospital—whether in Fordingbridge, which could be a centre for best practice or nursing excellence, or the hospital in Milford on Sea—the PCT response is that there is a difficulty because it is building a new hospital in Lymington. That is one of the first new hospitals in which the PCT will employ a private supplier to provide the health care. It does not yet know what services will be provided at Lymington, and will not therefore make any commitment about the services that need to be provided in any of the community hospitals. The new hospital in Lymington is due to open in January next year. Is that the way to run a national health service? We are only a few months away from the opening of the new hospital, yet we are told that decisions cannot be made about existing community hospitals because the PCT does not know about the services that it is commissioning at the new one.
	I understand my constituents' frustration and anger. They say, "Yes, expenditure on the NHS has increased enormously, as have our taxes—but have we had value for money?"

Siobhain McDonagh: I will not give way.
	As I have said, my constituency is one of the most disadvantaged in our strategic health authority's catchment area, with some of the greatest health needs, yet when the axe had to fall throughout the '80s and early '90s it was my constituency that suffered most. In the past few months, we have uncovered secret plans by the local health authority dating back to the mid-1990s. It proposed to shut St. Helier, but thankfully was unable to do so before Labour came to power.
	St. Helier hospital is not in my constituency—it is in a Liberal Democrat constituency—but it serves half of my constituents. The health establishment has for many years scorned Mitcham and Morden. Even now, despite many complaints from me, no one who lives in my constituency is on any NHS board, either of a primary care trust or a hospital trust. So I should not have been surprised when St. Helier came under threat again more recently, when the administrators decided that they wanted to remove critical services from the hospital. It was saved only following the intervention of my right hon. Friend the Secretary of State for Health.
	Those administrators argued that the site of the main hospital—the critical care hospital—was not important, as the community hospitals would take most of the people who normally go to hospitals. A public consultation was conducted, and it soon became clear that the main issue would be where to put the new critical care hospital, which would house the area's accident and emergency unit, and acute services such as maternity and obstetrics.
	My view is that the people who need critical care services the most are those who are most disadvantaged and have the worst health. There is a strong link between social disadvantage and the need for emergency services and health needs such as low birth weight and teenage pregnancy. The bulk of the population live near St. Helier, and the vast majority of those with the greatest health needs live there. They are those with the lowest life expectancy, those who experience the most emergency admissions, the highest levels of child accidents, the lowest levels of good health and the most long-term illnesses. The also include those with the most babies with low birth weight, the least access to primary care, the lowest incomes and the least access to cars. The area also has the largest black and ethnic minority population. For all those reasons, I felt that having the critical care hospital at St. Helier was the best way to reduce health inequalities. The public consultation seemed to agree—[Interruption.]

Siobhain McDonagh: Madam Deputy Speaker, the Conservatives do not like to hear the truth, but I will continue with this speech and I will not be abused—[Interruption.]

Richard Taylor: I take that point.
	The debate is about management of the NHS, so I shall refer first to reforms. In 2002–03, the Health Committee's report inquiring into foundation trusts started with a table quoted from the Journal of the Royal Society of Medicine, which listed the reforms that had taken place between 1982 and 2003 under Governments of different colours. There were 12 reorganisations between 1982 and 1997, another six between 1997 and 2003, and since then, as panic has set in, there have been at least 10 more—practice-based commissioning, payment by results, "Agenda for Change", new contracts, reorganisation of trusts, independent sector treatment centres, out-of-hours care, the computer program, the primary care White Paper and the abolition of the Commission for Patient and Public Involvement in Health. The NHS is supposed to be patient-led, but none of those have come up from the bottom; they are all top-down.
	For example, by and large, independent sector treatment centres are against local wishes. I have just received a letter from one of my ex-housemen, who is now a professor of magnetic resonance imaging. In respect of independent sector scanners, he wrote:
	"I am not aware of any attempt at all to evaluate whether or not the NHS could have provided this extra capacity. Many NHS MR systems are under-utilised owing to either revenue or staff shortages."
	He also wrote:
	"There was no consultation locally on Wave 1—it was presented as a 'fait accompli'"
	In relation to primary care trust mergers, everyone in my area is against the loss of their own PCT for their own part of the county. That has been made clear at all levels, and any movement on the matter is most unlikely. I have heard other Members make similar comments this afternoon. PCT mergers are not in accordance with local wishes; they are top-down.
	The abolition of the Commission for Patient and Public Involvement in Health will have a devastating effect on local forums, removing the very bodies that could communicate the patients' and public's needs and wishes. Abolishing the CPPIH two years after its institution does not strike me as good management. Equally, abolishing PCTs just two to three years after inception, just as they are beginning to work, does not seem to me to be good management.
	The Government-inspired reforms, especially their number and top-down nature, lead to problems. The person who wrote the article listing the number of reforms from 1982 to 2003, quoted in the Health Committee report that I mentioned, wrote subsequently that
	"perpetual reform is very costly, both in terms of the time and effort invested by managers and other NHS staff, and in terms of the financial costs of establishing the physical fabric of new organisations and of meeting the redundancy or retirement costs of displaced staff. It can create a significant diversion of time and effort from the focus on delivering improvements to patient care, and, crucially, may promote a cynical attitude to innovation and change in the NHS".
	The Health Committee report on the merger of primary care trusts followed up that theme. In our summary, we wrote:
	"It is clear that the impact of proposed reconfigurations on PCTs' day to day functions, including clinical services, will be substantial—it takes on average eighteen months for organisations to 'recover' after restructuring and to bring their performance back to its previous level."
	We continued:
	"After the immediate disruption of reorganisation, it is thought to take a further 18 months for the benefits to emerge—a total of three years from the initial reforms. Thus, just as the benefits of PCTs (established in 2002) are about to be realised, the Government has decided to restructure them."
	The Government attempt to justify the NHS deficits on the basis that they only affect a minority of trusts. In relation to the 2005–06 deficits, that seems to be the case. What we desperately need to know—I am pleased that the Health Committee will undertake an inquiry about this in future, as we might then find out the real scale of the deficit—is what savings all trusts across the country must make to be in balance by the end of 2006–07. That will give us some idea of the true deficit.
	I have thoroughly welcomed the extra money that has gone into the NHS, but the Health Committee has heard some worrying facts about what happened to the extra £6.6 billion this year. Nearly half has gone on pay rises and other expected things, but much of the other half has gone on uncosted or inaccurately costed contracts, PFI costs, independent sector costs, the computer system and the pharmacy contract. At that stage, there has been mismanagement of the vast amount of extra money that has gone in.
	With regard to the private finance initiative, would people now allow a PFI contract to be written with a clause stating that if bed occupancy goes above 90 per cent, there would be extra payment? Before the changes removing the need for some hospital beds, not all of which have taken place, as the hon. Member for Dartford (Dr. Stoate) mentioned, initial PFIs were made with fewer beds. Allowing a contract to have a penalty clause for occupancy levels that would inevitably be reached was inexcusable. During one meeting of the Health Committee, we tried to find out from top civil servants how widespread the practice was. The civil servants promised to send a note because they could not answer at the time, but I think we are still waiting for that note.
	There is another sad aspect of the private finance initiative. Forecasts were made of its unaffordability, and my own trust has now admitted that approximately £7 million of its deficit of nearly £30 million is owing to the PFI.
	We should also ask what managers in any concern other than the health service would allow independent-sector treatment centres a fixed contract for a guaranteed number of cases, to be paid for within a fixed time regardless of whether they have been dealt with, while at the same time NHS treatment centres struggle to make ends meet? That strikes me as a little odd, and it strikes me as poor management.
	Another thing that worries me, and worries many people in the NHS is who would go fast and furious down the road to privatisation when there is so much opposition from health workers of all kinds? The fact of resistance is proved by the appearance of the group called "Keep Our NHS Public", which has been joined by a good many junior doctors.
	Some expenses resulting from Government rulings on top-down management seem to me fairly ridiculous. They may be controversial and I may be wrong, but I want to mention them. Clinical risk managers, for instance, are senior nurses who have been taken away from their jobs looking after patients in order to manage risk. Has there been any study of their value for money? The same question could be asked about quality managers. As for the plethora of "modern matrons", that is really just another name for the departmental nursing officers whom we have had for years and years.
	The typical image of a matron is that of the archetypal figure in a smart uniform who sails around a hospital and puts the fear of death into all the nurses and doctors. That one person can do more in terms of risk, quality and the standard of care than any number of highly paid modern matrons. If I were looking for savings, rather than getting rid of practising, working nurses on the wards I would get rid of risk managers and quality managers. I would return the modern matrons to their jobs as nursing officers and bring back "the matron" who is not bothered by management or the reforms that she must introduce, but is purely and simply concerned with quality.

Kali Mountford: The hon. Lady is trying to have her cake and eat it, as ever, but that is the Liberal Democrat way, is it not? It is important—[Interruption.] The hon. Member for Beverley and Holderness (Mr. Stuart), who has been rather excited throughout the debate, should try to contain himself. He will doubtless get his opportunity to speak at some point. I await that with bated breath.

Kali Mountford: In fact, my community disagrees with the PCT. The community want an ordinary maternity unit in the local hospital and does not want a midwife-led unit, so we are on opposite sides of the argument. My personal view is that midwife-led units can, in the right circumstances and with the right support, be of great benefit. Midwives are the right people to make decisions and help a mother through all prenatal care, the delivery of the baby and some of the postnatal care. The relationship that can be built up over a period of time is valuable to a safe birth and important in helping mothers to take decisions that lead them away from unnecessary interventions, such as elective caesareans. As soon as a pregnant woman visits the local maternity unit, she sees shiny pieces of equipment and thinks, "Oh my God, I need some of that. It is bound to all go wrong and I want to ensure that I am as near to that equipment as possible." That has been the undercurrent of the debate on health.
	Some people in the community claim that the issue is cuts in public spending on health, but nothing could be further from the truth. In fact, the argument started five years ago when the health authority took a decision against the advice of the hospital, which wanted to move maternity services into one huge unit—a sort of super maternity unit. We rejected those plans, although the hospital claimed at the time that it was a matter of clinical need. The hon. Member for Wyre Forest has mentioned clinical need, but the problem is that clinical decisions are not always straightforward. Clinicians argue about them all the time. Indeed, clinicians from all over the country came to my constituency to argue about the best way forward for delivering babies. There is not only one point of view or one way of delivering excellence. That is fine, if the community backs the eventual decision. If everybody in my community demanded a midwife-led unit, I would not blame them for doing so, because it could be an excellent move. However, if it were introduced against the wishes of the community, we would have a problem, because it would be set up to fail—[Interruption.] The hon. Member for Westbury (Dr. Murrison) laughs, but—

Kali Mountford: The hon. Gentleman needs to think again about how he presents his argument—[Laughter.] Well, Opposition Members laugh, but they are misrepresenting the case. It is the primary care trusts who are charged with the task of consulting the hospital trusts and making the decisions. It was a clear decision by the Government that such decisions should be made locally, and that is where the next dichotomy arises. The community in my area want one thing, but the PCT and the hospital trust have come to a different conclusion. I want decisions to be taken locally that take account of the community's views. Where do we go from there? Well, we go to the Secretary of State, who then acts as an arbiter.
	My personal view is that we should have an independent inquiry into the issue. PCTs must take their responsibility for their communities seriously. They are charged with the duty of consulting properly. In this case, no fewer than 100,000 people—assuming that people signed only one of the petitions—made their views known, and if the PCT does not take account of that, it should look closely at the way in which it makes decisions—[Interruption.] Opposition Members are giggling and perhaps they will share the joke with the House when they make their own contributions. Why do Opposition Members think that it is funny that I want to champion the cause of my community, which has had a dreadful experience with a consultation with the PCT?
	I have had several meetings, and a debate in Westminster Hall, about this matter. I am unhappy that my constituents will not get the service that they are demanding, but also at issue are important questions about how we set up the local delivery of health services. How do we charge PCTs with the task of making sure that those services are what is wanted by the people who, through their taxes, pay their wages? That should be a simple question for Opposition Members to understand, but ensuring that we have a democratic NHS might be too difficult for them.
	The hon. Member for Wyre Forest (Dr. Taylor) said that clinicians were the only people who should take such decisions, and that the balance must lie somewhere between the outrage exhibited by Opposition Members on the one hand and that expressed by Labour Members on the other. He may be right about that, but arguments about the local delivery of the NHS should not cause us to blame the Government for local decisions, nor to do the opposite—that is, scurry back to the Government about every local decision that we do not like.
	The argument is difficult, but there is one matter about which I agree with Opposition Members, so perhaps they should not giggle quite so much. The hospital trust in my area is being reconfigured, but changes in the PCT are also being considered, as I shall explain.
	The PCTs have more money to spend in our communities than ever before, and they control huge budgets for the delivery of community services to our constituents. That is valid and valuable but, when PCTs were being set up, I argued fiercely that they should be as local as possible. I was very glad that it was decided that my PCT should be very small, as my community is very different from the ones that surround it. I thought it important that my constituents' views about how their money is spent on their health services should be taken properly into account, and I still do.
	My right hon. Friend the Member for Rother Valley (Mr. Barron) spoke about health inequalities. The inequalities that exist between my constituency and that of my hon. Friend the Member for Huddersfield (Mr. Sheerman) are very stark. Given that PCTs are being reviewed, it is important that the proposed new structures are looked at.
	I have made a counter-proposal and I hope that the Government will listen to it. It should be clear to the House that I place great value on giving people in the community a say in how the NHS is run. I understand why a bigger PCT could deliver better value for money, and why bigger management teams could be slimmed down. However, I fear that that approach could cause us to lose something that I value very much—community involvement in the NHS. The House may not value that as much as I do, but I believe that that is how we can make sure that what is delivered is in the best interests of my community.
	My proposal is that we look at how we can build a smaller, locality-based form of PCT into the overarching management committee that covers a number of PCTs. I have discussed the idea at length with my right hon. Friend the Secretary of State and other Ministers. The advantage would be that funding for each area could be ring fenced and so deal in part with the problem raised by my right hon. Friend the Member for Rother Valley. That is, people in richer areas would not be able to raid the funds of the poorer areas.
	There is a huge difference in how the two PCTs in my area are funded. The per capita funding has been greatly reduced for people living in areas where health inequalities have had less impact, whereas it has been greatly improved for the poorest people. That has to be right, but my fear is that a much larger PCT would have an adverse effect on the management of health inequalities.
	Such problems matter. If we do not think about patients' experience of the NHS, value what they say about what they want and stop the richest raiding the funds of the poorest, how can those who need the most get what they need? I hope that Ministers and the Secretary of State will look carefully at the proposals for the Kirklees PCT, and the proposals that I have made about making the best use of resources. I accept that an over-arching executive board would be cheaper than having three separate boards, but we must retain the important and valuable role played by non-executive board members. Their work as advocates for their local communities will mean that, when future consultations are held about the provision of health services in my area, people can be assured that they will get value for money and the health service that they crave.

Brian Binley: I am proud to be covered by such a scheme, as there is room in the business for both sectors. Indeed, it is important that we attract more money into health. I am surprised that the hon. Gentleman does not realise that more money needs to be spent on health or that we need to find various ways to attract it. He may wish to take that lesson on board.
	Northamptonshire is desperately underfunded. We have heard that there are many problems and that people wish to transfer money from the wealthy areas to the poor ones. I am not sure that we are a poor area, but we are certainly heavily underfunded in local government, policing and health. The Minister for Local Government acknowledged those problems but did not act to deal with them when I visited him in December last year. They are caused by various factors—I shall not go into all of them, because time forbids—but a serious shortfall has resulted from the formulaic underfunding of Northamptonshire in general and Northampton in particular. We face an additional problem as the result of the sustainable communities programme that the Government have forced on us, but which most of us reject. There is sizable growth, but the need to fund extra medical provision has simply not been recognised by the Government.
	The most serious problems are in health. Leicestershire, Rutland and Northamptonshire strategic health authority is the worst-funded SHA relative to the notional capitation formula. Together with our PCTs, it was underfunded by £88 million—5.3 per cent. of the budget—and thus significantly below the capitation funding level at the end of the last financial year. Northampton general hospital faces severe demands for a reduction in spending in two areas in particular. It has been forced to reduce spending on the 2006–07 budget by £7.8 million or 4.5 per cent. of the budget, which means reductions in the length of stay and staffing—particularly health service staff, as well as increased day care treatment. Doctors may wish to recommend that a patient remain in hospital, but the hospital fears that it cannot allow them to do so.
	In addition, the hospital faces a further reduction of another £8 million because of the transfer of certain functions to the primary care sector. I accept that that is Government policy, but it creates a massive challenge for both the hospital and the primary care sector, as there will be a 10 per cent. cut in the hospital budget and a 5 per cent. minimum increase in work load for the primary care sector. Any business man knows that there is a huge risk attached to such change within a year. I am not sure that the Government have understood what that risk element means. I can tell them. It means possible cuts in services, a lack of resource to service the requirements, and less good treatment for the patient. On top of that, we have a further problem in Northamptonshire because £25 million of underfunding has been carried forward.
	The Office for National Statistics said that we were to have no growth in Northampton between 2001 and 2008. I invite the Minister to come to Northampton. By God, he will see growth on a massive scale, yet the ONS said that we were to have no growth, which meant that we were not funded. That was accepted by the Government. What have they done? They have given us slightly increased growth for 2006–07, but have taken no account of the £25 million underfunding.
	That is placing a massive burden on the primary care trust. I plead with the Minister to reconsider. Please come back to us with a more favourable view. That is what I mean by flexibility in the system. It is okay looking down from the macro level. I understand why you make the decisions that you do. I understand the problems that you are faced with and what you are trying to achieve, but at the micro level the impact is different and needs to be understood equally well. It will not be understood unless you come to my constituency and other constituencies around me—

Diana Johnson: I disagree with the hon. Members for Guildford (Anne Milton) and for Northampton, South (Mr. Binley). I passionately believe that the NHS and health care is a political matter. Hon. Members who choose to vote against increases in funding to the NHS and health care are making a clear political statement by doing so, and that is to be regretted.
	In the city that I represent in East Yorkshire, Hull, we have people who are severely disadvantaged in terms of the economic success that they enjoy, the jobs that they are able to get and the health care that they were able to access in the past. Examining and investing in public health in Hull is key to the future prosperity and regeneration of Hull and that part of East Yorkshire. The life expectancy of a man in Hull is at least two and half years off the national average. For a woman, the corresponding figure is just over a year. That says something about the health of people in Hull. We need to discover where health inequalities exist and address them.
	In Hull we have single-handed GP practices, with GPs operating in small houses that they have changed into surgeries. Those are not suitable for the kind of health care that we need in 2005–06. In the past, the emphasis was on acute hospitals—district general hospitals. We will always need hospitals, but we also need to ensure that we invest in our community sector. I was pleased that there was some debate earlier about the LIFT programme and the money that the Government have identified to go into enhanced service delivery for GPs, linked to the wider regeneration of areas such as Hull.
	I would like to deal with the effect on my constituency of the massive investment that has been put into it over the last few years, particularly in respect of the Hull and East Yorkshire NHS hospitals trust, an acute trust. About £6 million has been invested in the creation of the Hull and East Yorkshire eye hospital and £35 million has been put into the building of the Hull and East Yorkshire women and children's hospital, which opened two years ago. Plans are afoot—the first contractors are on site—to build a £45 million cardiac and elective surgical facility at the Castle Hill hospital site, and £60 million is available for a new oncology centre at Castle Hill. Several other smaller capital developments are either planned or already in progress. My constituents are really seeing the benefits of massive investment in the NHS in Hull and east Yorkshire.
	My area in Hull is rated ninth out of the 354 local authorities and districts in the country in respect of disadvantage and deprivation: health care is thus a key issue for us. I was very pleased that the Hull York medical school came to the Hull university site a few years ago, which meant that we were training doctors who would, we hoped, decide to make their careers in the Hull and East Riding area. We put in a bid for a new dental school, but it was unfortunately not successful. I remain hopeful of another round and another strong bid from the Hull York site, which should be viewed favourably by the Government.
	I want to finish with a few comments on some recent visits that I have made. The first was to the East Yorkshire eye hospital. I encountered a fabulous NHS staff team there, including a consultant who told me that, from the day he sees someone who needs a cataract operation, he can be operating nine days later. I believe that that is phenomenal when we think that a few years ago, people in Hull and elsewhere had to face months of misery before having a cataract operation. Nine days is brilliant and something to be very proud of.
	We should also pay tribute to the flexible way in which NHS staff now work. It was interesting to hear from the hon. Member for Wyre Forest (Dr. Taylor) about what I thought was a rather old-fashioned way of demarcating doctors, nurses, matrons and so forth. What I felt was so refreshing when I visited the eye hospital was the fact that the consultant, the nurses and the administrators worked incredibly well together to ensure that the patient experience was the best possible. It was a real team, which recognised the importance of working as a team. There was no pulling rank in the sense that the consultant had considerable experience while others did not: they operated as a team, which demonstrates the way forward.
	I would like to say a few words about the Hull and East Yorkshire women and children's hospital, which provides midwifery-led care. We also have the Jubilee birth centre, which is totally midwife led, but the costs are quite high. We have to think about costs and the type of facilities that we provide to expectant parents.

Stephen Hammond: I want to make two brief points. First, I welcome the two new Ministers—the hon. Member for Leigh (Andy Burnham) and the hon. Member for Bury, South (Mr. Lewis)—to their posts and wish them success.I have sat through the long debate, in which we had, with one notable exception, thought-provoking, valid contributions of quality.
	My first point is a macro point. No hon. Member wants the NHS to be out of financial balance. However, the Government's macro reality is that they are spending £96 billion on the NHS, whereas my micro reality is that my local acute hospital and my PCT are in deficit. The Government's macro reality is that, as the Secretary of State said, the financial problems are always created by the trusts. That is not so. The bulk of my constituents in Wimbledon look to St. George's as their acute hospital, which is in the constituency of the hon. Member for Tooting (Mr. Khan). I have spoken to the financial director, Mr. Colin Gentile, and the turnaround team has done a good job. However, one of the problems that exacerbated the deficit was the inability of the Department of Health to get its tariffs correct in the first place. Although the Government say that the problems are always caused by the trusts, that is not the case.
	Secondly, let me consider the local point. The hon. Member for Mitcham and Morden (Siobhain McDonagh), who is no longer in her place, made an ill-tempered contribution, in which she allowed no interventions. Her constituency is next to mine and we share a borough council and a health reality. The health reality that she portrayed was not that that some of us experience. Yes, several improvements have taken place at Sutton and Merton PCT but she should also have said that it has deficits. Some are due to overspending, which it needs to put right, but others, as in the case of St. George's healthcare trust, are due to a problem about which it could do nothing. An arbitration settlement from three years ago hit it. Community practice nurses, the district nursing service and the home health visiting service are consequently being cut. The White Paper states that community health provision should not be cut as a result of short-term budgetary issues. I ask Ministers to think about that.
	The hon. Member for Mitcham and Morden also spoke a lot about the "Better Healthcare Closer to Home" project, and about her supposedly great victory in retaining St. Helier hospital. St. Helier was never going to be closed: it was either going to be a local care centre or an acute care trust. She misrepresented the situation several times, and I look forward to reading Hansard carefully tomorrow and, I hope, making some points of order and asking for some corrections.
	The overwhelming point is that, although the Secretary of State granted the hospital a reprieve as an acute care trust, she failed to consider what would happen to the local care trusts. As a result of that decision, the whole "Better Healthcare Closer to Home" project has now gone into abeyance, and the business case has been distorted. My constituents in Wimbledon, who want to see excellent local primary care delivered through the local care hospital, can no longer be certain that that will happen, either in the given time scale or at all. I am seeking reassurance from the Ministers that it will happen.

Patrick McLoughlin: rose in this place and claimed to move, That the Question be now put.
	Question, That the Question be now put, put and agreed to.

Question put accordingly, That the original words stand part of the Question:—
	The House divided: Ayes 236, Noes 309.

That the draft Planning (Application to the Houses of Parliament) Order 2006, which was laid before this House on 19th April, be approved.—[Mr. Roy.]
	Question agreed to.
	Motion made, and Question put forthwith, pursuant to Standing Order No. 118(6) (Standing Committees on Delegated Legislation),

That the Statement of Changes in Immigration Rules (HC 1016), dated 30th March 2006, be referred to a Standing Committee on Delegated Legislation.—[Mr. Roy.]
	Question agreed to.

MODERNISATION OF THE HOUSE

Motion made,
	That Mr Geoffrey Hoon and Liz Blackman be discharged from the Select Committee on Modernisation of the House of Commons and Mr Jack Straw and Paddy Tipping be added.—[Mr. Roy.]

Hon. Members: Object.

PETITIONS
	 — 
	Bovine Tuberculosis

Tail Docking

Bill Wiggin: This important petition concerns tail docking. Many people who breed dogs feel happy unhappy about the Government's proposals.
	The Petition of dog breeders, dog owners and dog lovers,
	Declares that dog breeds are docked for their own welfare against injury and infection. Scientists across the globe agree that tail docking does not cause pain as newborn dogs and their nervous systems are relatively immature at birth.
	The Petitioners therefore request that the House of Commons urge the Government to revise its proposals to amend current legislation on tail docking and to preserve the petitioners' freedom of choice.
	And the Petitioners remain, etc.
	To lie upon the Table.

Julian Lewis: Anybody looking at the title of this Adjournment debate could be forgiven for anticipating that I am yet another Conservative Member standing up to complain about the Government's closure of an RAF base. That would be very far from the truth. I am delighted to say that the Minister has been giving the utmost support and consideration to my efforts to prevent the closure of the base. He has been able to do that not only because he has safely survived the reshuffle, which I am delighted to see—[Interruption.] I am delighted that he is delighted. He has also been able to do it because RAF Hythe is not a British base at all. Since 1967, when General de Gaulle threw NATO bag and baggage out of France in the atmosphere of fraternal French military support to which we have become so accustomed, the base has been a US army facility in my constituency. It masquerades under the title of a Royal Air Force base and deals primarily with water craft, as one would expect given such consistency so far.
	What RAF Hythe has done over these years is quite phenomenal. It has developed from what was originally a storage base into an advanced network of shipbuilding maintenance repair and upgrading skills that is second to none in the US armed forces. That has been acknowledged. In order to give the House an idea of what the equipment that is so well looked after by the personnel at RAF Hythe is for, I ask hon. Members to imagine the Mulberry harbours, which, perhaps by coincidence, were also developed, constructed and deployed from the Solent and Southampton Water region. Mulberry harbours were the artificial harbours that enabled a port to be opened on the coastline of occupied France when opposed landings were being made.
	That is the work to which RAF Hythe has been essentially committed. It is involved in the preparation of causeways and the maintenance and upgrading of port-opening vessels, floating cranes, and medium-sized and small landing craft. Another particular line of expertise has been the maintenance of fleets of small vessels that were originally deployed on the back of a very large ship based in Diego Garcia, a place that I may mention again later. That large vessel, which was a semi-submersible, would be able to transport the small vessels to anywhere they were needed, flood down, and float them off, and thereby enable a floating point of deployment for the application of military force to a hostile shore.
	Over the years, the staff of RAF Hythe, who are, with the exception of two or three American personnel, entirely British, have been called upon to perform many functions, and they have never failed. They wrote the textbooks on the way to dehumidify and preserve water craft and other military assets so that they can be pre-positioned in various theatres around the world. What is more, they developed the techniques and wrote the manual for bringing those dehumidified and otherwise stored assets safely back into service and ready for deployment within a 10-day period. In 2002, it was decided that 30 of those vessels should be pre-positioned to serve the far east theatre at Yokohama north dock in Japan. In 2003–04, a similar pre-positioning of another 30 such vessels was arranged to be carried out in Kuwait naval base. That was in no way to diminish the role of Hythe, which was integral to setting up those two bases and has been essential in carrying out the missions that the bases perform.
	At Yokohama north dock, an attempt was made to contract out one of the less skilled functions that the direct US army-employed work force of Hythe had previously performed. It was such a failure both in the quality of the work and the cost that the services of ITT, the contractor company, were dispensed with and Hythe was recommissioned to carry on with the work.
	The key document to which I shall refer is an audit, which was carried out early this year and presented on 13 March to Major-General Johnson, who is at army field support command at Rock Island, Illinois. That is the next step up in the chain of command from which the facility at Hythe derives its work and instructions. The audit examined four options for continuing the work, which the work force at Hythe, who are directly employed by the US army, has hitherto carried out.
	Option 1 was to carry on with Hythe, option 2 was to continue with full and open competition, and options 3 and 4 were to use other agencies that had done similar bits of work, which related to part of the functions that Hythe had hitherto performed either for the Army or the US navy and ascertain whether they could apply.Five criteria applied: technical capability of sustaining the water craft; overall cost of the operation; contract duration; lead time to the award, and resident skills and expertise.
	Let me give the assessment of option 1—Hythe. The audit, by the US army's audit agency, found in favour of Hythe that maintenance costs were projected to be significantly lower through continuing with Hythe than the contracted operation alternatives of options 2, 3 and 4. It found that there was a completely trained work force, total resident knowledge and technical capability, and that Hythe provided maximum flexibility, resident expertise to support exercises and no security problems because all employees are security cleared through their affiliation to the US army.
	What was against Hythe? Only two things. The base closure was stated to be already in process, although nothing had been announced and no explanation has ever been given, and Hythe was not funded for the financial year 2007 and beyond.
	Options 3 and 4 did not come close. It is interesting that one of the arguments against option 2 was:
	"Readiness may be impacted if any delays to contract award by 30 September FY06",
	and that it would be a lower risk if the award date were postponed until 31 December 2007.
	At the end of the process, a matrix was produced showing the four options and judging them against the five criteria. Hythe was the only one to score a 1—the top grading—for technical capability, a 1 for overall cost, and a 1 for resident expertise. The other two criteria, which covered contracts and how long it would take to get the operation up and running, did not apply because Hythe is already up and running. So Hythe had a top score of 3—the lower the score, the better. Option 2 scored 10.5, option 3 scored 16, and option 4 scored 12.5.
	This resulted in the realisation that, whereas it would cost $18.42 million for Hythe to carry on doing what it does, both locally and in running the bases in Japan and Kuwait, that sum would be at least doubled by option 2, to $37.73 million. The cost of closing Hythe—we assume that the Americans would act in good faith and pay off the pension fund in full—would have to be added to that $37.73. That would involve another $72.85 million, making a grand total of more than $110 million in the first year, compared with $18.42 million.
	Three additional vessels in Hythe have been separately budgeted for, which would keep the base going until the end of 2007. That would lessen the risk even if option 2 were chosen. When that is taken into account, we need to add another $27 million to the costs that would result from the closure, because the uncompleted boats would have to be towed back across the Atlantic for completion in US dockyards. If they stayed at Hythe, however, and if the work force were allowed to continue to work on them for that extra year, it would cost only an extra $10 million. In other words, this is the economics of the madhouse.
	The audit recommended to the commanding general in Rock Island, Illinois, that the closure notice that was under way—for reasons that have never been explained—should be rescinded, and that Hythe offered by far the best value for money. We do not know what went on when that audit report was received at the Rock Island base in Illinois. We do know, however, that no explanation has been given, and that no notice of any significance has been given. There seems to be a desperate rush to close the base at Hythe before the end of the American financial year on 30 September.
	By contrast, other bases that carry out only part of the work—in Germany and Italy, for example—are not being closed, even though the base at Germersheim in Germany consistently fails to meet its targets. It carries out work not on the water craft but on flat-bed trailers and mobile military generators, in which Hythe also specialises. A similar function is carried out at a base at Livorno in Italy, which has frequently been beset by labour troubles and strikes.
	We wonder whether Hythe is being picked on in this way because the American army authorities feel that it would be easier to divest themselves of their loyal work force in England than to divest themselves of people who are not direct employees of the US Army, and who are protected by all sorts of labour laws in countries on the continent that have shown themselves to be somewhat less reliable to the United States of America when the chips are down than have the people from this base in the United Kingdom.
	In short, we have a facility that is versatile to the extent that when it was invited to send volunteers to Afghanistan, 14 went, and let us remember that they are civilians and do not get medals or other recognition. Incidentally, volunteers were requested from the Rock Island headquarters, and I believe that three were obtained. Out in Afghanistan, the volunteers from Hythe were able to turn their hands to augmenting the armour on armoured vehicles to protect the lives of US service personnel. This is an expert force: as I said, it wrote the manual for the preservation and reactivation techniques of pre-positioned stocks. It is an economical force—it is half the cost to the US taxpayer compared with the next best option, and that is only the yearly cost, apart from the colossal closure costs to which I have referred. It is a reliable force and has never taken industrial action in well over 30 years of service to the United States of America.
	I have little time left, as I am anxious to hear the Minister's reply. I shall therefore mention quickly some of Hythe's commendations. One says:
	"Reserve Storage Activity Hythe is official commended for extraordinary meritorious service in support of Operation Desert Storm".
	Another says:
	"Presented to Reserve Storage Activity, Hythe, for your outstanding support during the Somalia deployment".
	Another reads:
	"Certificate of Appreciation . . . Presented to Combat Equipment Base-North Atlantic, Hythe, England. In recognition of your outstanding support and contributions to Task Force 143 during the . . . download of the MV American Cormorant".
	That is from Diego Garcia, an important base. We are showing rather more support to the Americans than they might perhaps be said to deserve given the way that they are treating RAF Hythe. On one occasion, RAF Hythe was told:
	"Your commitment to excellence directly contributed to improvements in United States Army force projection capabilities".
	It also received an official commendation:
	"Their efforts, long hours and dedication has ensured that the work has been completed in a timely manner and within budget constraints."
	Some of the tributes that I have read go back a number of years, but here is one from last Tuesday, from the manager of the watercraft equipment site at the Kuwait naval base:
	"Just a note to let you all know that the crew of maintenance personnel I have out here supporting our mission is doing a superb job"—
	those are the Hythe people out in Kuwait. It continues:
	"They are well ahead of our forecasted production schedule, in fact so much so that we feel we can have 7 of the 8 LCUs"—
	landing craft—
	"at 10/20, minus the C41SR equipment, by the end of the"
	financial year. It continues:
	"The skill set mix is right for what we have to accomplish, very little diverting skills to another skill requirement."
	Reading through the jargon, I think that that means that Hythe is doing a very good job.
	I do not have time to quote from the 30 letters that I have from different companies whose ancillary business is worth £4.5 million to the local economies of this country. Those businesses are not just from around Southampton but from areas as far afield as Leicester, Sunderland and Cwmbran.
	Will the Minister meet the work force, enlist the aid of the Foreign Office and, in particular, make written representations to the American authorities on behalf of the continuation of Hythe? There is no strategic reason for its closure or political justification for closing what amounts to 95 per cent. of the US army's footprint in this country. There is no economic justification, as it is a betrayal of the US taxpayer as much as of our ancillary industries, and there is certainly no moral justification for the closure.